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Testosteron und Prostata

Testosterone and the prostate

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Zusammenfassung

Da Testosteron eine entscheidende Rolle beim Verlauf von benignen und malignen Prostataerkrankungen spielt, sind die physiologischen Interaktionen von Testosteron und Prostatagewebe und die Besonderheiten der Hormonersatztherapie bei Patienten mit Prostataerkrankungen für praktisch tätige Urologen von entscheidender Bedeutung.

Unter einer Testosteronsubstitutionstherapie zeigen sich keine signifikanten Veränderungen des PSA-Werts bzw. des Prostatavolumens. Obwohl Langzeituntersuchungen an Männern mit einem Androgendefizit fehlen, erscheint eine Testosteronsubstitution unter regelmäßiger Kontrolle der Prostata mittels Sonographie und PSA-Wert möglich und die Gefahr der Induktion eines Prostatakarzinoms nicht erhöht.

Bei hypogonadalen Männern mit nachgewiesener „High-grade-PIN“ trat unter der Testosteronsubstitution im Beobachtungszeitraum in 1/20 Fällen bei suspektem Tastbefund ein manifestes Karzinom auf, die PSA-Werte zeigten keinen Unterschied zwischen Patienten mit und ohne PIN.

Dennoch bleibt es unklar, ob eine Testosteronsubstitution nach erfolgreicher radikaler Prostatektomie durchgeführt werden soll.

Abstract

Testosterone has a distinct role in benign and malignant diseases of the prostate. Therefore, knowledge about the physiological interactions between testosterone and the prostate and the special circumstances under testosterone substitution are of great impact for urologists.

PSA value and prostate volume do not show significant changes under testosterone substitution therapy. Even if there are no long-term studies in men under substitution due to decreased testosterone, the therapy seems to be safe under regular control of the prostate with PSA and sonography, and the risk for prostate carcinoma is not increased.

In hypogonadal men with high-grade PIN under testosterone substitution, 1 in 20 cases with suspicious rectal examination exhibited a carcinoma; the PSA values did not show a difference between men with or without PIN.

Nevertheless, it remains unclear whether men after successful radical prostatectomy should receive testosterone substitution.

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Literatur

  1. Behre HM, Bohmeyer J, Nieschlag E (1994) Prostate volume in testosterone-treated and untreated hypogonadal men in comparison to age-matched normal controls. Clin Endocrinol 40:341–349

    CAS  Google Scholar 

  2. Bruchovsky N, Rennie PS, Batzold FH, Goldenberg SL, Fletcher T, McLoughlin MG (1988) Kinetic parameters of 5 alpha-reductase activity in stroma and epithelium of normal, hyperplastic, and carcinomatous human prostates. J Clin Endocrinol Metab 67:806–816

    CAS  PubMed  Google Scholar 

  3. Drafta D, Proca E, Zamfir V, Schindler AE, Neacsu E, Stroe E (1982) Plasma steroids in benign prostatic hypertrophy and carcinoma of the prostate. J Steroid Biochem 17:689–693

    Article  CAS  PubMed  Google Scholar 

  4. Frick J, Jungwirth A, Rovan E (1998) Androgens and the prostate. In: Nieschlag E, Behre H (Hrsg) Testosterone. Springer, Berlin Heidelberg New York Tokyo

  5. Gerstenbluth RE, Maniam PN, Corty EW, Seftel AD (2002) Prostate-specific antigen changes in hypogonadal men treated with testosterone replacement. J Androl 23:922–926

    PubMed  Google Scholar 

  6. Habib FK, Ross M, Bayne CW, Bollina P, Grigor K, Chapman K (2003) The loss of 5-alpha-reductase type I and type II mRNA expression in metastatic prostate cancer to bone and lymph node metastasis. Clin Cancer Res 9:1815–1819

    CAS  PubMed  Google Scholar 

  7. Holmäng S, Marin P, Lindstedt G, Hedelin H (1996) Effect of long-term oral testosterone undecanoate treatment on prostate volume and serum prostate volume and serum prostate-specific antigen concentration in eugonadal middle-aged men. Prostate 23:99–106

    Google Scholar 

  8. Hsing AW, Reichardt JK, Stanczyk FZ (2002) Hormones and prostate cancer: current perspectives and future directions. Prostate 52:213–235

    Article  CAS  PubMed  Google Scholar 

  9. Imperato-McGinley J, Gautier T, Zirinsky K et al. (1992) Prostate visualization studies in males homozygous and heterozygous for 5 alpha-reductase deficiency. J Clin Endocrinol Metab 75:1022–1026

    Article  CAS  PubMed  Google Scholar 

  10. Jin B, Conway AJ, Handelsman DJ (2001) Effects of androgen deficiency and replacement on prostate zonal volumes. Clin Endocrinol (Oxf) 54:437–445

    Google Scholar 

  11. Jockenhövel F (1999) Männlicher Hypogonadismus—Aktuelle Aspekte der Androgensubstitution. UNI-MED, Bremen

  12. Krieg M, Nass R, Tunn S (1993) Effect of aging on endogenous level of 5 alpha-dihydrotestosterone, testosterone, estradiol, and estrone in epithelium and stroma of normal and hyperplastic human prostate. J Clin Endocrinol Metab 77:375–381

    Article  CAS  PubMed  Google Scholar 

  13. Krithivas K, Yurgalevitch SM, Mohr BA et al. (1999) Evidence that the CAG repeat in the androgen receptor gene is associated with the age-related decline in serum androgen levels in men. J Endocrinol 162:137–142

    CAS  PubMed  Google Scholar 

  14. Luo J, Dunn TA, Ewing CM, Walsh PC, Isaacs WB (2003) Decreased gene expression of steroid 5 alpha-reductase 2 in human prostate cancer: implications for finasteride therapy of prostate carcinoma. Prostate 57:134–139

    Article  CAS  PubMed  Google Scholar 

  15. Massengill JC, Sun L, Moul JW et al. (2003) Pretreatment total testosterone level predicts pathological stage in patients with localized prostate cancer treated with radical prostatectomy. J Urol 169:1670–1675

    PubMed  Google Scholar 

  16. Meikle AW, Smith JA, Stringham JD (1989) Estradiol and testosterone metabolism and production in men with prostatic cancer. J Steroid Biochem 33:19–24

    Article  CAS  PubMed  Google Scholar 

  17. Pechersky A, Mazurov I, Semiglazov V, Karpischenko A, Mikhailichenko V, Udintsev A (2002) Androgen administration in middle-aged and ageing men: effects of oral testosterone undecanoate on dihydrotestosterone, oestradiol and prostate volume. Int J Androl 25:119–125

    Article  CAS  PubMed  Google Scholar 

  18. Pickles T, Agranovich A, Berthelet E et al. (2002) Testosterone recovery following prolonged adjuvant androgen ablation for prostate carcinoma. Cancer 94:362–367

    Article  CAS  PubMed  Google Scholar 

  19. Rhoden EL, Morgentaler A (2003) Testosterone replacement therapy in hypogonadal men at high risk for prostate cancer: results of 1 year of treatment in men with prostatic intraepithelial neoplasia. J Urol 170:2348–2351

    CAS  PubMed  Google Scholar 

  20. Schatzl G, Madersbacher S, Thurridl T, Waldmuller J, Kramer G, Haitel A, Marberger M (2001) High-grade prostate cancer is associated with low serum testosterone levels. Prostate 47:52–58

    Article  CAS  PubMed  Google Scholar 

  21. Schweikert H, Tunn U (2000) Endokrinologie. In: Höfner K, Stief C, Jonas U (Hrsg) Benigne Prostatahyperplasie. Springer, Berlin Heidelberg New York Tokyo

  22. Sih R, Morley JE, Kaiser FE, Perry HM, Patrick P, Ross C (1997) Testosterone replacement in older hypogonadal men: a 12-month randomized controlled trial. J Clin Endocrinol Metab 82:1661–1667

    Article  CAS  PubMed  Google Scholar 

  23. Snyder PJ, Peachey H, Hannoush P et al. (1999) Effect of testosterone treatment on body composition and muscle strength in men over 65 years of age. J Clin Endocrinol Metab 84:2647–2653

    Article  CAS  PubMed  Google Scholar 

  24. Stoner E (1992) The clinical effects of a 5 alpha-reductase inhibitor, finasteride, on benign prostatic hyperplasia. The Finasteride Study Group. J Urol 147:1298–1302

    CAS  PubMed  Google Scholar 

  25. Svetec DA, Canby ED, Thompson IM, Sabanegh ES (1997) The effect of parenteral testosterone replacement on prostate specific antigen in hypogonadal men with erectile dysfunction. J Urol 158:1775–1777

    CAS  PubMed  Google Scholar 

  26. Tenover JS (1992) Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab 75:1092–1098

    Article  CAS  PubMed  Google Scholar 

  27. Yeh S, Chang C (1996) Cloning and characterization of a specific coactivator, ARA70, for the androgen receptor in human prostate cells. Proc Natl Acad Sci USA 93:5517–5521

    Article  CAS  PubMed  Google Scholar 

  28. Zhang PL, Rosen S, Veeramachaneni R, Kao J, DeWolf WC, Bubley G (2002) Association between prostate cancer and serum testosterone levels. Prostate 53:179–182

    Article  PubMed  Google Scholar 

  29. Zitzmann M, Depenbusch M, Gromoll J, Nieschlag E (2003) Prostate volume and growth in testosterone-substituted hypogonadal men are dependent on the CAG repeat polymorphism of the androgen receptor gene: a longitudinal pharmacogenetic study. J Clin Endocrinol Metab 88:2049–2054

    Article  CAS  PubMed  Google Scholar 

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  1. Urologische Klinik, Universitätsklinikum, Essen

    H. Sperling, R. Rossi, G. Lümmen & H. Rübben

  2. Urologische Klinik, Universitätsklinikum, Hufelandstraße 55, 45122 , Essen

    H. Sperling

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  1. H. Sperling
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  2. R. Rossi
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  3. G. Lümmen
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  4. H. Rübben
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Correspondence to H. Sperling.

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Sperling, H., Rossi, R., Lümmen, G. et al. Testosteron und Prostata. Urologe [A] 43, 1092–1096 (2004). https://doi.org/10.1007/s00120-004-0654-y

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